AB0862 Association of emotional dysfunction with gastrointestinal symptoms and disease activity in patients with spondyloarthritis
Authors: Á. Arzuaga, J. A. Sucerquia Quintero, J. M. Bello-Gualtero, J. De Avila, W. Bautista-Molano, C. Romero-Sánchez
Journal: Annals of the Rheumatic Diseases (2022)

Background Spondyloarthritis (SpA) is a heterogeneous condition characterized by chronic back pain, fatigue and progressive loss of mobility, associated to decreasing quality of life, physical and mental health. SpA patients may have a presence of non-specific gastrointestinal symptoms or subclinical intestinal inflammation. Although the association between SpA and high levels of distress has been investigated, few studies have included gastrointestinal involvement among the factors associated with mental health. Objectives To evaluate emotional functionality of patients with SpA, and their association with the presence of gastrointestinal symptoms and disease activity. Methods In total, 98 patients with SpA (fulfilling ASAS criteria) were assessed by rheumatologists. Patients with two or more gastrointestinal symptoms were referred to gastroenterology. Furthermore, those patients with SpA and concomitant IBD were excluded. BASDAI, BASFI, ASDAS-CRP, ASDAS-ESR were performed. Patient Health Questionnaire (PQH9) for depression and Perceived Stress Scale-10 (PSS10 for Distress and confrontation) were used to assess clinical and psychological status. Fecal Calprotectin, CRP, ESR, and HLA-B*27:05 were assessed. The associations were evaluated using the Chi-square or Fisher’s exact test and U de Mann-Whitney. Spearman and Pearson test were made to explore correlations (Ethical/Code. 2017-023). Results The average age of patients was 42.3±10.5 years, 58.2% were men and 42.9% presented the HLA-B*27:05 allele. Axial involvement (77.60%), peripheral involvement (46.90%), and ≥2 gastrointestinal symptoms in the last month (65.30%) were found. With regard to outcome measures of disease activity, BASDAI 4.75±2.74 and ASDAS-CRP 2.44 ±0.95 was observed. In total, 72.4% of patients had some degree of depression: 22.4% mild, 20.4% moderate, 12.2% high moderate and 11.2% severe. Male gender was associated with higher frequency of depression, 51% of them presented with moderate to severe involvement (p=0.036). The presence of ≥2 gastrointestinal symptoms was associated with a higher frequency of depression (p=0.013), taking importance the presence of abdominal pain in 57.2% (p=0.007), it is also associated with fatigue (p &lt; 0.001) and with higher scores of disease activity BASDAI (CC 0.696), ASDAS-CRP (CC 0.590) ASDAS-ESR (CC 0.519) and BASFI (CC 0.737) (p &lt; 0.001 respectively). Considering the PSS-10 assessment, 21.4% of patients had higher levels of distress, which were associated with the presence of abdominal pain (p=0.038), BASDAI&gt;4 (p=0.047), ASDAS-CPR &gt; 3.5 (p=0.013). Additionally, 57.1% of patients reported more frequency of decreased confrontation capacity which was related with fatigue (p=0.013), BASFI&gt;4 (p=0.028), ASDAS-CRP &gt;2.1 (p=0.03) and HLA-B*27:05 (p=0.06). These variables were simultaneously associated with higher levels of distress (p=0.035, p=0.004, p=0.03 and p=0.06 respectively). Conclusion Disease activity and gastrointestinal symptoms in SpA patients without IBD, are associated with emotional dysfunctional outcome related to poor quality of life. These findings highlight the importance of a holistic monitoring towards remission of SpA patients ensuring an emotional functional balance. Acknowledgements The Ministry of Science, Technology, and Innovation - MinCiencias (Grant No. 130877757442). Hospital Militar Central (Grant 2017-023), Clínicos IPS, Gastroadvanced, Fundación Instituto de Reumatología Fernando Chalem-Bogota, Colombia and Biomedicina de Chihuahua, México Disclosure of Interests Ángelo Arzuaga: None declared, Julian Andres Sucerquia Quintero Employee of: Novartis de Colombia Janssen - Cilag, Juan Manuel Bello-Gualtero: None declared, Juliette De Avila: None declared, Wilson Bautista-Molano: None declared, Consuelo Romero-Sánchez: None declared